Healthcare Provider Details

I. General information

NPI: 1265144331
Provider Name (Legal Business Name): RECOVERY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2022
Last Update Date: 12/20/2022
Certification Date: 12/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 N MECHANIC ST
CUMBERLAND MD
21502-2315
US

IV. Provider business mailing address

87 CARROLL AVE
KEYSER WV
26726-5022
US

V. Phone/Fax

Practice location:
  • Phone: 304-790-7467
  • Fax:
Mailing address:
  • Phone: 304-790-7467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: HEATHER LYNN ROSEN
Title or Position: OWNER
Credential: MD
Phone: 304-790-7467